BENZODIAZEPINES RENEWALS BEYOND RECOMMENDED DURATION IN FRANCE

1. BENZODIAZEPINES RENEWALS BEYOND RECOMMENDED DURATION IN FRANCE AN OBSERVATION OF THE DECISION-MAKING PROCESS IN GENERAL PRACTICE Département de médecine générale de Nantes Direction : Dr Jean-Paul CANEVET Presentation : Dr Cédric RAT

2. CONTEXT • Prescriptions : • More prescriptions of benzodiazepines than in other European countries • Long term benzodiazepine prescriptions are important • Recommandations : • No prescription of benzodiazepines over 12 weeks • No prescription of hypnotics over 4 weeks • General Practitioners : • Concerned by 84% of these drugs prescriptions

3. HYPOTHESIS SCIENCE RECOMMANDATIONS DECISION PATIENT’S REQUEST GP’ PREFERENCES

4. HYPOTHESIS SCIENCE RECOMMANDATIONS • UNBALANCE • in case of : • INSISTANT REQUEST FROM THE PATIENT DECISION PATIENT’S REQUEST GP’ PREFERENCES - CHRONIC CLINICAL SITUATIONS - COMPLEX SITUATIONS

5. PURPOSE SCIENCE RECOMMANDATIONS « RE EVALUTION BEFORE TREATMENT RENEWAL » Statistical links research DECISION « EXPLICIT REQUEST OF RENEWAL FROM THE PATIENT  » PATIENT’S REQUEST GP’ PREFERENCES « LENGTH OF DOCTOR/PATIENT RELATION » « OLD PATIENT »  « LENGTH OF TREATMENT CONSUMPTION » « COMPLEX SITUATIONS (co-morbidity, social cases…) »

6. PURPOSE SCIENCE RECOMMANDATIONS « RE EVALUTION BEFORE TREATMENT RENEWAL » Statistical links research DECISION « EXPLICIT REQUEST OF RENEWAL FROM THE PATIENT  » PATIENT’S REQUEST GP’ PREFERENCES Identification of GP's intentions and representations « LENGTH OF DOCTOR/PATIENT RELATION » « OLD PATIENT »  « LENGTH OF TREATMENT CONSUMPTION » « COMPLEX SITUATIONS (co-morbidity, social cases…) »

7. METHODS SCIENCE RECOMMANDATIONS Statistical links research A QUANTITATIVE METHOD, SAMPLE 77 GPs involved in trainees’ formation LOCATION 2 French departments TECHNIQUE direct observation of consultation SUPPORT grid of 22 items STATISTICAL ANALYSIS test χ2 , Student’s test DECISION GP’ PREFERENCES Identification of GP's intentions and representations

8. METHODS SCIENCE RECOMMANDATIONS Statistical links research A QUANTITATIVE METHOD, SAMPLE 77 GPs involved in trainees’ formation LOCATION 2 french departments TECHNIQUE direct observation of consultation SUPPORT grid of 22 items STATISTICAL ANALYSIS test χ2 , Student’s test DECISION GP’ PREFERENCES Identification of GP's intentions and representations A QUALITATIVE METHOD,

9. RESULTS QUANTITATIVE RESEARCH 245 grids completed, representing 56 GPs activity Median period of treatment :60 months None indicator of clinical re-evaluation identified : 40% of consultations Occurrence of an explicit patient’s demand of renewal : 50% of consultations

10. RESULTS QUANTITATIVE RESEARCH Yes Yes Yes No Yes !

11. CONCLUSION • 60% of the benzodiazepine renewals realised after a minimum re-evaluation ; • GPs do not abdicate : • . In case of patient request : more revaluation • . In case of complex situations : same evaluation • However : less evaluation with time … Demobilization ? Negligence ? Motivated intention ? SCIENCE RECOMMANDATIONS DECISION GP’ PREFERENCES PATIENT’S REQUEST GP's intentions and representations ?